Senate Health & Long Term Care advances three House bills in executive session; holds wide-ranging hearings on crisis care, parity, peers and provider pay

The Senate Health and Long Term Care Committee on March 25 advanced three House bills during an executive session and held public hearings on several bills tied to behavioral health, mental health parity and provider reimbursement.

The executive-session votes were voice votes; committee members then heard extended testimony on bills that would realign crisis services under Behavioral Health Administrative Service Organizations (BHASOs), create billing pathways for certified peer support specialists, require negotiating opportunities for independent providers, mandate evidence‑based clinical criteria for mental health medical‑necessity decisions, and require payment parity for advanced practice registered nurses and physician assistants in primary and behavioral health.

Why it matters: The bills under discussion affect how Washington funds and manages crisis stabilization, how Medicaid and commercial plans reimburse community providers and peers, and how insurers apply clinical criteria when authorizing mental health and substance use disorder care — all issues with immediate consequences for access to care, county and local budgets, and insurer premiums.

Votes at a glance

- Engrossed Substitute House Bill 13 95 (streamlining home care worker background checks): Committee adopted a striking amendment (S-2373.3) and the committee voted to give the bill a "due pass" recommendation and send it to the Rules Committee. The measure passed the committee by voice vote and was reported "passed subject to signatures." The committee recorded at least one named dissent during the vote.

- Engrossed Substitute House Bill 15 31 (preserving ability of public officials to address communicable diseases): The committee voted to give the bill a "due pass" recommendation and send it to the Rules Committee; the bill was reported "passed subject to signatures." A named dissent was recorded.

- Engrossed Substitute House Bill 19 71 (increasing access to prescription hormone therapy): The committee voted to give the bill a "due pass" recommendation and send it to the Ways and Means Committee; the bill was reported "passed subject to signatures." There was recorded opposition in the roll call discussion and at least one named "no."

Formal actions in the executive session were announced as voice votes and recorded in the minutes as "passed subject to signatures." The committee noted members who reserved floor amendments or who would bring amendments later in the Senate floor debate.

Behavioral‑health crisis services (Engrossed 2nd Substitute House Bill 18 13)

The committee reopened a public hearing on Engrossed Second Substitute House Bill 18 13, sponsored by Representative Nicole Macri, which directs the Health Care Authority (HCA) to develop a model of crisis delivery for each BHASO region, adjust Medicaid rates and state contracts to reflect changes in facility capacity, adopt a strategic procurement plan for Medicaid managed care contracts, and require MCOs by Jan. 1, 2026 to establish or expand delegation arrangements with BHASOs for crisis services.

Representative Nicole Macri (prime sponsor) told the committee she brought the bill because "people are not getting the care they need in a timely way," and described constituent cases of people with severe behavioral‑health needs who were unable to access services.

Advocates, county officials and providers described a funding and payment mismatch that has left crisis stabilization facilities unable to open or sustain operations. Steve O'Bannon, former state senator and former Pierce County advisor, testified that fragmented fee‑for‑service reimbursement to crisis providers has led some providers to exit the state and left empty crisis facilities in Pierce County. He said a "unitary funding system" under a local entity (the BHASO) would improve planning and investment.

Caitlin Stafford, Senior Health Policy Advisor to Governor Jay Inslee, told the committee the bill would also explore a tribal BHASO option and emphasized that "delegation is a delicate process" that requires standards and quality metrics.

Evan Klein of the Health Care Authority said the agency supports the bill's problem statement and would work with the sponsor on areas of clarity, while acknowledging funding remains a key challenge.

Local public safety and provider witnesses described concrete examples: the Connections Kirkland crisis center reported that 47 percent of its clients are Medicaid enrollees, and King County has provided ongoing levy funds because commercial funding pathways are inadequate; community crisis centers in other counties face unresolved operating shortfalls.

Supporters urged the committee to advance the bill so HCA and local BHASOs can better coordinate mobile crisis teams, crisis lines, facility‑based stabilization and transitions to ongoing care. Some managed‑care representatives sought narrower language or an interim process to resolve operational and claims‑processing details before full statewide adoption.

Certified peer support specialists (Second Substitute House Bill 14 27)

Representative Lauren Davis sponsored a bill to change the professional title from "certified peer specialists" to "certified peer support specialists," require HCA to contract with an external entity by Dec. 31, 2025 to expand peer access, and prioritize peer‑service accessibility in managed‑care procurement. The bill also directs development of three supplemental training courses for peers on domestic violence, sexual assault and human trafficking.

Davis and multiple peer leaders and recovery‑community organizations testified in support, arguing for sustainable billing pathways that would allow recovery community organizations and small, locally rooted programs to bill health carriers and continue providing peer services in jails, hospitals, outreach, and respite housing. Joshua Wallace (Pure Washington), Joseph Barsana (peer counselor), April Provost (Washington Recovery Alliance) and others described peer services as a proven, cost‑effective pathway that increases engagement and reduces recidivism. Proponents asked the committee to enable billing solutions (for example, third‑party administrators or a lightweight credential for peer‑only organizations) so small providers can participate in Medicaid and commercial reimbursement.

Provider networks and contract negotiation (Engrossed 2nd Substitute House Bill 15 89)

Representative Dan Bernofsky introduced HB 15 89, which would require health carriers to offer providers a meaningful opportunity to negotiate provider contracts and specify actions that would constitute failure to negotiate in good faith (for example, failing to provide contact information for the carrier's primary negotiator, failing to furnish redline and clean copies of contracts, or withholding fee schedules). The bill would also prohibit certain "all or nothing" clauses and give the Office of the Insurance Commissioner (OIC) additional enforcement authority.

A broad coalition of independent providers — chiropractors, naturopathic physicians, speech‑language pathologists, mental‑health clinicians and small clinical practices — testified in favor, saying many providers have not had meaningful reimbursement increases in years and that lack of negotiation contributes to providers leaving networks or declining to take insurance. Supporters argued the measure would help preserve independent practices that serve local communities.

Insurers and large carriers testified in opposition or with concerns, saying the bill would increase administrative costs and could prompt network‑narrowing responses that would reduce access. Jennifer Ziegler, representing the Association of Washington Health Care Plans, presented an actuarial estimate from a carrier that projected per‑member cost impacts and urged caution about cumulative premium effects from multiple health‑cost bills.

Mental health parity and medical‑necessity criteria (Engrossed 2nd Substitute House Bill 14 32)

Representative Tara Simmons brought forward a proposed striking amendment to HB 14 32 to refine state mental‑health parity law and require that commercial plans apply evidence‑based, age‑appropriate patient‑placement criteria consistent with nonprofit professional associations when making utilization‑management decisions. The amendment would also prohibit utilization review for an initial evaluation and up to six consecutive outpatient visits and would make the federal Mental Health Parity and Addiction Equity Act (and its implementing rules) applicable in state law.

Proponents — advocates, hospital and provider organizations, and university psychiatrists — said the bill closes a loophole now used to deny needed care by relying on proprietary or financially driven criteria rather than professional clinical standards. Jake Swanton (mental health advocacy organization Inseparable) said insurers' use of "proprietary" criteria is a "loophole that insurers use to deny necessary care." University of Washington psychiatry leaders and youth advocates urged passage, citing children and young adults denied timely treatment.

The Office of the Insurance Commissioner supported the striking amendment and recommended integrating the federal rule language as published (the transcript cites the federal MHPAEA implementation rule published 09/23/2024) and requested rulemaking authority and data access needed to evaluate nonquantitative treatment limitations.

Provider payment parity for ARNPs and PAs (Engrossed Substitute House Bill 14 30)

Representative Tara Simmons also sponsored HB 14 30, which would require commercial health plans (except public employee plans omitted in the current draft) issuing coverage after Jan. 1, 2026, to reimburse contracted advanced practice registered nurses (ARNPs) and physician assistants (PAs) at no less than the amount the carrier would reimburse a contracted physician for the same service in the same service area for primary care and behavioral health.

Supporters — including ARNPs, PAs and independent clinic owners — said lower reimbursement for mid‑level providers is a driver for provider closures and access problems, particularly in rural and underserved areas. Justin Gill, president of the Washington State Nurses Association and an urgent‑care nurse practitioner, urged the committee to pass the bill to preserve clinic doors in communities where ARNPs and PAs provide most front‑line care.

Opponents — led by physician specialty groups and some psychiatrists — warned the bill could worsen physician workforce shortages by reducing incentives for physician training and by risking premium increases. The Washington State Psychiatric Association and several individual psychiatrists argued that the measure would devalue physician training and could reduce psychiatrist availability for complex cases. Gary Franklin (L&I, UW) cited his team's research in the workers' compensation system showing comparable outcomes after ARNPs were authorized as attending providers and noted ARNPs increased service in rural areas in that system after payment parity was implemented there.

Discussion versus decision

Committee members and witnesses consistently distinguished discussion items (policy options, funding shortfalls, operational readiness) from formal committee action. The three bills voted in executive session were reported out of committee by voice vote; public hearings produced no final committee votes but generated requests for technical clarifications, suggested floor amendments and calls for interim work on implementation details (claims processing, delegation standards, data systems and funding sustainability).

What comes next

The three bills reported out in executive session will proceed to their next legislative steps (Rules or Ways and Means committees) as reported. Several bills that received public testimony will require additional drafting or interim stakeholder work: sponsors and agencies signaled a willingness to continue negotiations on delegation details (HB 1813), billing and technical implementation for peer services (HB 1427), insurer–provider negotiation mechanics (HB 1589), appropriate clinical criteria and OIC data access (HB 1432), and the scope and consequences of reimbursement parity (HB 1430).

Committee attendance and testimony

The record shows dozens of in‑person and remote testifiers, including state legislators, HCA staff, provider association leaders, county commissioners and law‑enforcement chiefs, recovery‑community leaders and representatives from carriers and the Office of the Insurance Commissioner. Several witnesses provided written follow‑up materials for committee staff.

Ending

Committee members signaled that several items will return to the floor with amendments and that many of the hearings will continue through written submissions and interim stakeholder work, particularly where implementation details (claims systems, delegation and funding) remain unsettled.